Social network analysis of physicians and their attitudes to evidence-based medicine

Here’s an interesting paper just out in BMC HSR. The authors sent a questionnaire to all (presumably, although they are a bit vague about that) physicians in an Italian healthcare organisation. They were asked some demographics, to name their peers with whom they discuss cases or seek or give advice, and then their attitudes to evidence-based medicine*.

Figure 1 from the paper: the social network of 297 physicians. CC-BY Mascia et al 2013

Then they found that being having positive EBM views predicted being at the core and well-connected in the network. Strange, really, because I would have seen the causality as the other way round, but never mind, the association is the same, albeit harder to explain the effect size. This is based on a core vs periphery classification but I wonder whether a spatial model (after multidimensional scaling perhaps?) would be better at utilising all the information, rather than splitting the network into two areas. Also, a structural equation model would make better use of the attitude data than just adding them together to get a score. Some parts of the network may score high in certain attitudes and low in others, thus cancelling out in an overall score.

Interesting stuff though, and worth doing in many other topics around clinician attitudes and preferences, which are such a mystery in a lot of what we do (“confounding by indication”).

* – if you haven’t encountered this term before, evidence-based medicine means treating your patients based on scientific research, not just what your professor told you when you were at med school (because he got it from his prof, and so on back to Ibn Sina, Galen and Aesclepios). People outside the healthcare world are generally rather shocked to find out there is anything other than EBM being practiced!


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